Topical steroids factsheet - Eczema

1 National Eczema Society Helpline: 0800 448 0818 Email: 1 Topical steroids factsheet Topical corticosteroids are the most common treatment for Eczema flare-ups (inflammation in Eczema ). They have been used to treat and control Eczema flare-ups for over 50 years and are recommended in NHS guidance as a first-line treatment for Eczema . In order for them to work effectively, they need to form part of a programme of treatments. A good skincare routine must be in place, involving the use of emollients to moisturise the skin and soap substitutes to cleanse it. Contact with substances that may dry or irritate the skin further should be reduced as far as possible. For some people with Eczema , the regular use of emollient preparations is all that is needed to keep their condition under control. However, for most people, Topical steroids will need to be used for short treatment bursts, at the correct strength to match the person s age, severity of Eczema and body area, to bring an Eczema flare-up under are Topical steroids ?

2 Topical means applied directly to the skin. steroids are a group of natural hormones, produced in the body by a variety of different glands. They are also produced synthetically as medicines and given as injections and in tablet form. Topical steroids act on the skin to reduce inflammation and speed up the healing of the skin. They also help to make the skin less red, hot, itchy and sore. They are not, however, a cure for Eczema . Topical steroid preparations are available as creams, ointments, lotions, foams, gels, mousses, shampoos and tape, and come in different strengths or potencies. Which Topical steroid /s you are prescribed will depend on the severity of your Eczema , your age, the part of your body that is affected and any other treatments you are using. When your Eczema is very dry, it is likely that your healthcare professional will prescribe an ointment-based preparation. Creams, which are light and cooling, may be used to treat moist, weepy or wet Eczema .

3 Lotions are easiest to apply on hairy areas of the body. There are two types of Topical steroid that can be bought over the counter from a pharmacy without a prescription: 1% hydrocortisone cream, a mildly potent Topical steroid , and Eumovate (clobetasone butyrate ), a moderately potent Topical steroid cream (see Table 1). 2A registered pharmacy can sell hydrocortisone and Eumovate as pharmacy (P) medicines; a prescription is not required, but they must be supplied under the supervision of a pharmacist for treating mild to moderate Eczema as well as allergic and irritant contact dermatitis and insect bites. When Topical steroids are supplied in this way ( without a prescription), they should NOT be used on the eyes or face, on broken or infected skin, on the anal or genital areas, in pregnancy, or by anyone under the age of 10 years (hydrocortisone) and 12 years (Eumovate) usage of this kind requires the guidance of a healthcare professional.

4 Hydrocortisone and Eumovate can only be bought in small tubes enough to treat small areas of Eczema . Most people with Eczema will need larger tubes, which are only available on prescription (sizes 30g, 50g-100g). Topical steroid potencies In the UK Topical steroid preparations are divided into four categories according to how strong or potent they are. The terms used are mild , moderately potent , potent and very potent . The potency of Topical steroids is determined by the amount of vasoconstriction (narrowing of the blood vessels) they produce. It also relates to the degree to which the Topical steroid inhibits inflammation, and its potential for causing side effects. It can be difficult for the person with Eczema or the parent of a child with Eczema to work out Topical steroid factsheet National Eczema Society Helpline: 0800 448 0818 Email: 2 3the potency of a product, since the labelled percentage of steroid on the packaging does not relate to the potency and may sometimes imply a less potent product.

5 The potency of the Topical steroid may be stated in the patient information leaflet (PIL) inside the packaging. One way of understanding the strength of different steroid preparations is to note that moderately potent is twice as potent as hydrocortisone 1%; potent is 10 times more potent; and very potent 50 times more potent. If you are not sure of the potency of a steroid preparation, ask your pharmacist. A list is provided in this factsheet , but new preparations may not be included. The potency of the steroid you are given will be based on several factors: Age: Babies and children with mild to moderate Eczema are usually prescribed mild Topical steroids . Sometimes, when Eczema is more severe or there is no response to a mild steroid , moderate to potent Topical steroids may be prescribed for short periods and under medical supervision. Severity of the Eczema : A mild or moderately potent steroid may be replaced by a stronger potency if the Eczema flares up, with very potent steroids prescribed by specialists for very severe flares.

6 4 Body site: Areas of thick skin, such as the feet and the hands, can be treated with potent preparations. For thinner skin, such as the face and genital areas, mild and moderately potent preparations are commonly prescribed; a potent steroid will only be used for severe, unresponsive Eczema in these areas, usually for a limited period. If the steroid is applied to the body folds, ( armpits, skin between buttocks), the occlusive effect increases its potency, so milder preparations should be used. Size of the affected area: A weaker strength might be prescribed when a large area of skin requires treatment. Other treatments: If bandaging forms part of the treatment, a weaker steroid may be chosen because bandaging will increase the potency of the steroid . NB. You may be given more than one Topical steroid to treat Eczema in different areas of the body. Make sure that you are clear which preparation to use where.

7 If in doubt, talk to your pharmacist or contact your doctor/nurse. Table 1: Topical steroids Trade name This is the name chosen by the manufacturer it is in big print on the tube. The following are examples of trade names, but this is not a complete list. You will also find that some Topical steroids do not have a trade name only a generic name. Generic name This is the official name of the steroid it is usually written in smaller print on the tube. Strength Potency this is not indicated on the tube but may be stated in the PIL inside the packaging. Dermacort (available only over the counter) Hydrocortisone Mild Dioderm Hydrocortisone Mild Hc45 (available only over the counter) Hydrocortisone 1% Mild Hydrocortisone Hydrocortisone Mild Hydrocortisone 1% Hydrocortisone 1% Mild Hydrocortisone Hydrocortisone Mild Mildison Lipocream Hydrocortisone 1% Mild Synalar 1 in 10 Fluocinolone acetonide Mild Zenoxone cream Hydrocortisone 1% Mild Table 1 shows Topical steroids listed alphabetically by trade name according to their strength.

8 Topical steroid factsheet National Eczema Society Helpline: 0800 448 0818 Email: 3 Table 1: Topical steroids continued Trade name This is the name chosen by the manufacturer it is in big print on the tube. The following are examples of trade names, but this is not a complete list. You will also find that some Topical steroids do not have a trade name only a generic name. Generic name This is the official name of the steroid it is usually written in smaller print on the tube. Strength Potency this is not indicated on the tube but may be stated in the PIL inside the packaging. Alphaderm Hydrocortisone 1%, urea 10% Moderate Betnovate-RD Betamethasone valerate Moderate Clobavate Clobetasone butyrate Moderate Eumovate Clobetasone butyrate Moderate Haelan (available as cream, ointment and tape) Fludroxycortide Moderate Modrasone Alclometasone dipropionate Moderate Synalar 1 in 4 Fluocinolone acetonide Moderate Ultralanum Plain Fluocortolone hexanoate Potent Betacap (scalp application) Betamethasone valerate Potent Beclometasone dipropionate Beclometasone dipropionate Potent Betnovate Betamethasone valerate Potent Bettamousse (scalp application) Contains mg betamethasone valerate , per gram Potent Cutivate ointment Fluticasone propionate Potent Cutivate cream Fluticasone propionate Potent Diprosalic (ointment and scalp preparation)

9 Betamethasone dipropionate Potent Diprosone Betamethasone dipropionate Potent Elocon Mometasone furoate Potent Locoid (available as scalp application and lotion Locid Crelo ) Hydrocortisone butyrate Potent Metosyn Fluocinonide Potent Nerisone Diflucortolone valerate Potent Synalar Fluocinolone acetonide Potent Clarelux (scalp application) Clobetasol propionate Very potent Dermovate Clobetasol propionate Very potent Etrivex (shampoo) Clobetasol propionate Very potent Nerisone Forte Diflucortolone valerate Very potent Topical steroid factsheet National Eczema Society Helpline: 0800 448 0818 Email: 4 If your healthcare professional feels that your Eczema could be infected, you may be prescribed a combination preparation that contains ingredients aimed at fighting the infection (see Table 2 below). Table 2: Topical steroids with antimicrobial effects Trade name This is the name chosen by the manufacturer it is in big print on the tube.

10 The following are examples of trade names, but this is not a complete list. You will also find that some Topical steroids do not have a trade name only a generic name. Generic name This is the official name of the steroid it is usually written in smaller print on the tube. Main anti-microbial effect Which type of infection it is used for. Added antimicrobials Strength Potency this is not indicated on the tube but may be stated in the PIL inside the packaging. Canesten HC Hydrocortisone 1% Antifungal Clotrimazole Mild Daktacort Hydrocortisone 1% Antifungal Miconazole nitrate Mild Fucidin H Hydrocortisone 1% Antibacterial Fusidic acid Mild Nystaform HC Hydrocortisone Antibacterial Antifungal Chlorhexidine Nystatin Mild Terra-Cortril Hydrocortisone 1% Antibacterial Oxytetracycline Mild Timodine Hydrocortisone Antibacterial Antifungal Benzalkonium chloride Nystatin Mild Trimovate Clobetasone butyrate Antibacterial Antifungal Oxytetracycline Nystatin Moderate Aureocort Triamcinolone acetonide Antibacterial Chlortetracycline hydrochloride Potent Betamathasone and clioquinol Betamethasone valerate Antibacterial Clioquinol Potent Betamethasone and neomycin Betamethasone valerate Antibacterial Neomycin sulphate Potent Fucibet Betamethasone valerate Antibacterial Fucidic acid Potent Lotriderm Betamethasone dipropionate Antifungal Clotrimazole